Id: flow-HighRiskExclusions
Url: High Risk Exclusions
Version: 1.0.0
Title: High Risk Exclusions
Status: draft
Experimental: true
Type:

system: http://terminology.hl7.org/CodeSystem/plan-definition-type

code: eca-rule

Date: 2024-10-22
Publisher: MITRE
Description:

Clinical characteristics that have been identified in the USPSTF breast screening recommendation statement as indicative of higher than average risk and therefore excluded from recommendation statement patient population. Provides criteria to determine age to start and age to stop, screening modality, and screening interval for these populations of patients.
Knowledge Capability: executable
Knowledge Representation Level: structured
Copyright:

(C) 2024 The MITRE Corporation. All Rights Reserved. Approved for Public Release: 24-2711. Distribution Unlimited. Unless otherwise noted, this work is available under an Apache 2.0 license. It was produced by the MITRE Corporation for the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention in accordance with the Statement of Work, contract number 75FCMC18D0047, task order number 75D30123F17931.
Approval Date: 2024-10-22
Libraries:
Library/HighRiskExclusions|1.0.0
Actions:
Annual screening mammogram starting age 30: An annual screening mammogram starting at age 30 is recommended. Women who are at higher than average risk for breast cancer based on known genetic markers or syndromes should get a mammogram every year, typically starting at age 30.
If: Applicability: (ExistsACSGeneticRiskMammo)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (ACSGeneticRiskMammoCode)
%action.timingTiming: (ACSGeneticRiskMammoTiming)
%action.extension: (ACSGeneticRiskMammoFlag)
code.coding[0]: (ACSGeneticRiskMammoCode)
reasonCode[0].coding[0]: (ACSGeneticRiskMammoReason)
occurrenceDateTime: (ACSGeneticRiskMammoTimingEvent)
Annual screening MRI starting age 30: An annual screening MRI starting at age 30 is recommended. Women who are at higher than average risk for breast cancer based on known genetic markers or syndromes should get a breast MRI every year, typically starting at age 30.
If: Applicability: (ExistsACSGeneticRiskMri)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (ACSGeneticRiskMriCode)
%action.timingTiming: (ACSGeneticRiskMriTiming)
%action.extension: (ACSGeneticRiskMriFlag)
code.coding[0]: (ACSGeneticRiskMriCode)
reasonCode[0].coding[0]: (ACSGeneticRiskMriReason)
occurrenceDateTime: (ACSGeneticRiskMriTimingEvent)
Refer to specialist recommendations: A number of other genetic variants are known to be associated with an increased risk of developing of breast cancer. For known personal history of these variants, refer to the consulting geneticist or to high risk breast specialist for guidance on routine screening. Variants may include ATM, BARD1, CDH1, CHEK2, NF1, PALB2, RAD51C, RAD51D, STK11.
If: Applicability: (ExistsSpecialtyReferralGeneticRisk)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (SpecialtyReferralGeneticRiskCode)
code.coding[0]: (SpecialtyReferralGeneticRiskCode)
reasonCode[0].coding[0]: (SpecialtyReferralGeneticRiskReason)
Annual screening mammogram: An annual screening mammogram starting 8 years after radiotherapy and no earlier than age 25 is recommended. Refer to patient's Oncologic treatment team or Survivorship Care Plan for patient specific guidance.
If: Applicability: (ExistsACSMammoAfterRT)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (ACSMammoAfterRTCode)
%action.timingTiming: (ACSMammoAfterRTTiming)
%action.extension: (ACSMammoAfterRTFlag)
code.coding[0]: (ACSMammoAfterRTCode)
reasonCode[0].coding[0]: (ACSMammoAfterRTReason)
occurrenceDateTime: (ACSMammoAfterRTTimingEvent)
Annual screening MRI: An annual screening MRI starting 8 years after radiotherapy and no earlier than age 25 is recommended. Refer to patient's Oncologic treatment team or Survivorship Care Plan for patient specific guidance.
If: Applicability: (ExistsACSMriAfterRT)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (ACSMriAfterRTCode)
%action.timingTiming: (ACSMriAfterRTTiming)
%action.extension: (ACSMriAfterRTFlag)
code.coding[0]: (ACSMriAfterRTCode)
reasonCode[0].coding[0]: (ACSMriAfterRTReason)
occurrenceDateTime: (ACSMriAfterRTTimingEvent)
Annual screening mammogram: Annual screening mammogram after 5 years from breast cancer onset is recomended.
If: Applicability: (ExistsACSMammoAfterBrca)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (ACSMammoAfterBrcaCode)
%action.timingTiming: (ACSMammoAfterBrcaTiming)
%action.extension: (ACSMammoAfterBrcaFlag)
code.coding[0]: (ACSMammoAfterBrcaCode)
reasonCode[0].coding[0]: (ACSMammoAfterBrcaReason)
occurrenceDateTime: (ACSMammoAfterBrcaTimingEvent)
Refer to Oncologic care plan: Previous breast cancer within 5 years may require enhanced surveillance including diagnostic mammogram. Refer to patient's Oncologic treatment team or Survivorship Care Plan for patient specific guidance.
If: Applicability: (ExistsSpecialtyReferralBreastCaWithin5y)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (SpecialtyReferralBreastCaWithin5yCode)
code.coding[0]: (SpecialtyReferralBreastCaWithin5yCode)
reasonCode[0].coding[0]: (SpecialtyReferralBreastCaWithin5yReason)
Annual screening mammogram starting age 30: An annual screening mammogram starting at age 30 is recommended. Women who are at higher than average risk for breast cancer based on past atypical biopsy should get a mammogram every year, typically starting at age 30.
If: Applicability: (ExistsACSMammoAtypicalBiopsy)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (ACSMammoAtypicalBiopsyCode)
%action.timingTiming: (ACSMammoAtypicalBiopsyTiming)
%action.extension: (ACSMammoAtypicalBiopsyFlag)
code.coding[0]: (ACSMammoAtypicalBiopsyCode)
reasonCode[0].coding[0]: (ACSMammoAtypicalBiopsyReason)
occurrenceDateTime: (ACSMammoAtypicalBiopsyTimingEvent)
Perform lifetime risk assessment: Consider performing assessment of lifetime risk. If estimated lifetime risk is >20%, patient may be eligible for supplemental screening with annual screening MRI.
If: Applicability: (ExistsACSAtypicalBiopsy)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (ACSAtypicalBiopsyCode)
code.coding[0]: (ACSAtypicalBiopsyCode)
reasonCode[0].coding[0]: (ACSAtypicalBiopsyReason)
Annual screening MRI starting age 30: An annual screening MRI starting at age 30 is recommended in patients with past atypical biopsy and lifetime risk > 20-25%.
If: Applicability: (ExistsACSMriAtypicalBiopsyHighRisk)
Then: Definition: http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0
Dynamic Values:
%action.code[0].coding[0]: (ACSMriAtypicalBiopsyHighRiskCode)
%action.timingTiming: (ACSMriAtypicalBiopsyHighRiskTiming)
%action.extension: (ACSMriAtypicalBiopsyHighRiskFlag)
code.coding[0]: (ACSMriAtypicalBiopsyHighRiskCode)
reasonCode[0].coding[0]: (ACSMriAtypicalBiopsyHighRiskReason)
occurrenceDateTime: (ACSMriAtypicalBiopsyHighRiskTimingEvent)
<type> <coding> <system value="http://terminology.hl7.org/CodeSystem/plan-definition-type"/> <code value="eca-rule"/> </coding> </type> <status value="draft"/> <experimental value="true"/> <date value="2024-10-22"/> <publisher value="MITRE"/> <contact> <name value="MITRE"/> <telecom> <system value="url"/> <value value="https://www.mitre.org/"/> </telecom> </contact> <description value="Clinical characteristics that have been identified in the USPSTF breast screening recommendation statement as indicative of higher than average risk and therefore excluded from recommendation statement patient population. Provides criteria to determine age to start and age to stop, screening modality, and screening interval for these populations of patients."/> <copyright value="(C) 2024 The MITRE Corporation. All Rights Reserved. Approved for Public Release: 24-2711. Distribution Unlimited. Unless otherwise noted, this work is available under an Apache 2.0 license. It was produced by the MITRE Corporation for the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention in accordance with the Statement of Work, contract number 75FCMC18D0047, task order number 75D30123F17931."/> <approvalDate value="2024-10-22"/> <lastReviewDate value="2024-10-22"/> <author> <name value="The Health FFRDC, operated by The MITRE Corporation, in support of the Division of Cancer Prevention and Control, Centers for Disease Control and Prevention."/> </author> <editor> <name value="Division of Cancer Prevention and Control, Centers for Disease Control and Prevention"/> </editor> <reviewer> <name value="Division of Cancer Prevention and Control, Centers for Disease Control and Prevention"/> </reviewer> <endorser> <name value="Division of Cancer Prevention and Control, Centers for Disease Control and Prevention"/> </endorser> <library value="Library/HighRiskExclusions|1.0.0"/> <action id="ACSGeneticRiskMammo"> <title value="Annual screening mammogram starting age 30"/> <description value="An annual screening mammogram starting at age 30 is recommended. Women who are at higher than average risk for breast cancer based on known genetic markers or syndromes should get a mammogram every year, typically starting at age 30."/> <documentation> <type value="citation"/> <label value="ACS"/> <display value="American Cancer Society Recommendations for the Early Detection of Breast Cancer"/> <url value="https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html"/> <document> <url value="https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html"/> </document> </documentation> <condition> <kind value="applicability"/> <expression> <language value="text/cql-identifier"/> <expression value="ExistsACSGeneticRiskMammo"/> </expression> </condition> <definitionCanonical value="http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0"/> <dynamicValue> <path value="%action.code[0].coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSGeneticRiskMammoCode"/> </expression> </dynamicValue> <dynamicValue> <path value="%action.timingTiming"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSGeneticRiskMammoTiming"/> </expression> </dynamicValue> <dynamicValue> <path value="%action.extension"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSGeneticRiskMammoFlag"/> </expression> </dynamicValue> <dynamicValue> <path value="code.coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSGeneticRiskMammoCode"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonCode[0].coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSGeneticRiskMammoReason"/> </expression> </dynamicValue> <dynamicValue> <path value="occurrenceDateTime"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSGeneticRiskMammoTimingEvent"/> </expression> </dynamicValue> </action> <action id="ACSGeneticRiskMri"> <title value="Annual screening MRI starting age 30"/> <description value="An annual screening MRI starting at age 30 is recommended. Women who are at higher than average risk for breast cancer based on known genetic markers or syndromes should get a breast MRI every year, typically starting at age 30."/> <documentation> <type value="citation"/> <label value="ACS"/> <display value="American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography"/> <citation value="Oeffinger KC, Fontham ETH, Etzioni R, et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA. 2015;314(15):1599–1614."/> <url value="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/canjclin.57.2.75"/> <document> <url value="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/canjclin.57.2.75"/> </document> </documentation> <condition> <kind value="applicability"/> <expression> <language value="text/cql-identifier"/> <expression value="ExistsACSGeneticRiskMri"/> </expression> </condition> <definitionCanonical value="http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0"/> <dynamicValue> <path value="%action.code[0].coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSGeneticRiskMriCode"/> </expression> </dynamicValue> <dynamicValue> <path value="%action.timingTiming"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSGeneticRiskMriTiming"/> </expression> </dynamicValue> <dynamicValue> <path value="%action.extension"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSGeneticRiskMriFlag"/> </expression> </dynamicValue> <dynamicValue> <path value="code.coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSGeneticRiskMriCode"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonCode[0].coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSGeneticRiskMriReason"/> </expression> </dynamicValue> <dynamicValue> <path value="occurrenceDateTime"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSGeneticRiskMriTimingEvent"/> </expression> </dynamicValue> </action> <action id="SpecialtyReferralGeneticRisk"> <title value="Refer to specialist recommendations"/> <description value="A number of other genetic variants are known to be associated with an increased risk of developing of breast cancer. For known personal history of these variants, refer to the consulting geneticist or to high risk breast specialist for guidance on routine screening. Variants may include ATM, BARD1, CDH1, CHEK2, NF1, PALB2, RAD51C, RAD51D, STK11."/> <condition> <kind value="applicability"/> <expression> <language value="text/cql-identifier"/> <expression value="ExistsSpecialtyReferralGeneticRisk"/> </expression> </condition> <definitionCanonical value="http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0"/> <dynamicValue> <path value="%action.code[0].coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="SpecialtyReferralGeneticRiskCode"/> </expression> </dynamicValue> <dynamicValue> <path value="code.coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="SpecialtyReferralGeneticRiskCode"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonCode[0].coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="SpecialtyReferralGeneticRiskReason"/> </expression> </dynamicValue> </action> <action id="ACSMammoAfterRT"> <title value="Annual screening mammogram"/> <description value="An annual screening mammogram starting 8 years after radiotherapy and no earlier than age 25 is recommended. Refer to patient's Oncologic treatment team or Survivorship Care Plan for patient specific guidance."/> <documentation> <type value="citation"/> <label value="ACS"/> <display value="American Cancer Society Recommendations for the Early Detection of Breast Cancer"/> <url value="https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html"/> <document> <url value="https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html"/> </document> </documentation> <condition> <kind value="applicability"/> <expression> <language value="text/cql-identifier"/> <expression value="ExistsACSMammoAfterRT"/> </expression> </condition> <definitionCanonical value="http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0"/> <dynamicValue> <path value="%action.code[0].coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAfterRTCode"/> </expression> </dynamicValue> <dynamicValue> <path value="%action.timingTiming"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAfterRTTiming"/> </expression> </dynamicValue> <dynamicValue> <path value="%action.extension"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAfterRTFlag"/> </expression> </dynamicValue> <dynamicValue> <path value="code.coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAfterRTCode"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonCode[0].coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAfterRTReason"/> </expression> </dynamicValue> <dynamicValue> <path value="occurrenceDateTime"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAfterRTTimingEvent"/> </expression> </dynamicValue> </action> <action id="ACSMriAfterRT"> <title value="Annual screening MRI"/> <description value="An annual screening MRI starting 8 years after radiotherapy and no earlier than age 25 is recommended. Refer to patient's Oncologic treatment team or Survivorship Care Plan for patient specific guidance."/> <documentation> <type value="citation"/> <label value="ACS"/> <display value="American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography"/> <citation value="Oeffinger KC, Fontham ETH, Etzioni R, et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA. 2015;314(15):1599–1614."/> <url value="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/canjclin.57.2.75"/> <document> <url value="https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/canjclin.57.2.75"/> </document> </documentation> <condition> <kind value="applicability"/> <expression> <language value="text/cql-identifier"/> <expression value="ExistsACSMriAfterRT"/> </expression> </condition> <definitionCanonical value="http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0"/> <dynamicValue> <path value="%action.code[0].coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMriAfterRTCode"/> </expression> </dynamicValue> <dynamicValue> <path value="%action.timingTiming"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMriAfterRTTiming"/> </expression> </dynamicValue> <dynamicValue> <path value="%action.extension"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMriAfterRTFlag"/> </expression> </dynamicValue> <dynamicValue> <path value="code.coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMriAfterRTCode"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonCode[0].coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMriAfterRTReason"/> </expression> </dynamicValue> <dynamicValue> <path value="occurrenceDateTime"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMriAfterRTTimingEvent"/> </expression> </dynamicValue> </action> <action id="ACSMammoAfterBrca"> <title value="Annual screening mammogram"/> <description value="Annual screening mammogram after 5 years from breast cancer onset is recomended."/> <documentation> <type value="citation"/> <label value="ACS"/> <display value="American Cancer Society Recommendations for the Early Detection of Breast Cancer"/> <url value="https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html"/> <document> <url value="https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html"/> </document> </documentation> <condition> <kind value="applicability"/> <expression> <language value="text/cql-identifier"/> <expression value="ExistsACSMammoAfterBrca"/> </expression> </condition> <definitionCanonical value="http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0"/> <dynamicValue> <path value="%action.code[0].coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAfterBrcaCode"/> </expression> </dynamicValue> <dynamicValue> <path value="%action.timingTiming"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAfterBrcaTiming"/> </expression> </dynamicValue> <dynamicValue> <path value="%action.extension"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAfterBrcaFlag"/> </expression> </dynamicValue> <dynamicValue> <path value="code.coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAfterBrcaCode"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonCode[0].coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAfterBrcaReason"/> </expression> </dynamicValue> <dynamicValue> <path value="occurrenceDateTime"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAfterBrcaTimingEvent"/> </expression> </dynamicValue> </action> <action id="SpecialtyReferralBreastCaWithin5y"> <title value="Refer to Oncologic care plan"/> <description value="Previous breast cancer within 5 years may require enhanced surveillance including diagnostic mammogram. Refer to patient's Oncologic treatment team or Survivorship Care Plan for patient specific guidance."/> <condition> <kind value="applicability"/> <expression> <language value="text/cql-identifier"/> <expression value="ExistsSpecialtyReferralBreastCaWithin5y"/> </expression> </condition> <definitionCanonical value="http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0"/> <dynamicValue> <path value="%action.code[0].coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="SpecialtyReferralBreastCaWithin5yCode"/> </expression> </dynamicValue> <dynamicValue> <path value="code.coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="SpecialtyReferralBreastCaWithin5yCode"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonCode[0].coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="SpecialtyReferralBreastCaWithin5yReason"/> </expression> </dynamicValue> </action> <action id="ACSMammoAtypicalBiopsy"> <title value="Annual screening mammogram starting age 30"/> <description value="An annual screening mammogram starting at age 30 is recommended. Women who are at higher than average risk for breast cancer based on past atypical biopsy should get a mammogram every year, typically starting at age 30. "/> <documentation> <type value="citation"/> <label value="ACS"/> <display value="American Cancer Society Recommendations for the Early Detection of Breast Cancer"/> <url value="https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html"/> <document> <url value="https://www.cancer.org/cancer/types/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html"/> </document> </documentation> <condition> <kind value="applicability"/> <expression> <language value="text/cql-identifier"/> <expression value="ExistsACSMammoAtypicalBiopsy"/> </expression> </condition> <definitionCanonical value="http://cancerscreeningcds.github.io/bcsm-cds/ActivityDefinition/BreastCancerScreeningServiceRequest|1.0.0"/> <dynamicValue> <path value="%action.code[0].coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAtypicalBiopsyCode"/> </expression> </dynamicValue> <dynamicValue> <path value="%action.timingTiming"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAtypicalBiopsyTiming"/> </expression> </dynamicValue> <dynamicValue> <path value="%action.extension"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAtypicalBiopsyFlag"/> </expression> </dynamicValue> <dynamicValue> <path value="code.coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAtypicalBiopsyCode"/> </expression> </dynamicValue> <dynamicValue> <path value="reasonCode[0].coding[0]"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAtypicalBiopsyReason"/> </expression> </dynamicValue> <dynamicValue> <path value="occurrenceDateTime"/> <expression> <language value="text/cql-identifier"/> <expression value="ACSMammoAtypicalBiopsyTimingEvent"/> </expression> </dynamicValue> </action> <action id="ACSAtypicalBiopsy"> <title value="Perform lifetime risk assessment"/> <description value="Consider performing assessment of lifetime risk. If estimated lifetime risk is >20%, patient may be eligible for supplemental screening with annual screening MRI."/> <documentation> <type value="citation"/> <label value="ACS"/> <display value="American Cancer Society Guidelines for Breast Screening with MRI as an Adjunct to Mammography"/> <citation value="Oeffinger KC, Fontham ETH, Etzioni R, et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. 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Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. 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